Psychotic Disorders

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Psychotic Disorders

• DSM-IV

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Psychosis

• Psychosis is a condition characterized by a loss
  of contact with reality.
• Hallucinations false perceptions
• Delusions false beliefs

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Examples of Hallucinations and Delusions

• Hallucinations
• Hearing voices
• Seeing visions
• Experiencing odd tastes, smells
• Experiencing odd feelings

• Delusions
• Persecution
• Grandeur
• Somatic
• Jealousy
• Erotomania
• Thought control
• Behavior control
• Thought withdrawal

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Psychoses may be caused by

• Drugs e.g., LSD, Amphetamines, Cocaine
• Brain Diseases e.g., Alzheimers Disease
• Brain Injuries e.g., trauma, stroke
• Extreme stress e.g., war, kidnapping,
• Bipolar and major depressive disorders
• Schizophrenia--most common cause

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Some Recent Cases

• Ted Kaczynski--the unabomber
• Mark David Chapman--killed John Lennon
• John Hinckley--shot President Reagan
• Andrea Yates--drowned her five children
• Note most schizophrenics are not violent

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A few facts about schizophrenia

• Usually diagnosed in late teens/early 20s
• Means split mind Eugen Bleuler
• Affects approximately 1 of people
• Men have more severe cases
• 10-15 commit suicide
• More common among the poor

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Diagnosing Psychiatric Disorders

• All psychiatric disorders including schizophrenia
  are diagnosed on the basis of clusters of
  symptoms
• There is no brain scan, no urine test, no blood
  test, no cerebral spinal fluid test that can be
  used to diagnose schizophrenia

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Positive and Negative Symptoms

• Positive
• Hallucinations
• Delusions
• Disordered speech
• Bizarre behavior
• Good response to drugs, normal brain ventricles,
  limbic system abnormalities

• Negative
• Emotionally flat
• Poverty of speech
• Associality
• Apathy
• Avolition
• Frontal lobe abnormalities, enlarged ventricles,
  variable response to drugs

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Diagnostic Criteria for Schizophrenia

• Delusions
• Hallucinations
• Disorganized Speech
• Disorganized or catatonic behavior
• Negative Symptoms (deficits)
• Two or more of the above must be present for at
  least one month and some disturbance for six
  months
• Significant impairment in social/occupational
  functioning

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Disorganized Speech

• Disorder of thought form
• Loose Associations
• Thought derailment
• Neologisms (making up words)

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Etiology (Causal Factors)

• No one factor can fully explain
• Very good evidence for genetic transmission of a
  predisposition
• Probably polygenic
• Suspect chromosomes 22, 6, 8, and 1
• Some evidence for other biological factors

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Genetic Studies

• Family studies risk increases as number of
  shared genes increases
• Twin studies concordance rate higher in
  identical than fraternal twins
• Adoption studies biological relatives show
  increased risk

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Other suggested causal factors

• Prenatal viral infections, esp. 4 -7 month
• Rh incompatibility between mother and baby
• Early nutritional deficiencies
• Birth complications

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Other Biological Aspects

• Enlarged ventricles
• 3 reduction in overall brain volume
• Amygdala, frontal lobes, temporal lobes,
  hippocampus, thalamus
• Most brains look normal
• Dopamine
• Glutamate

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Treatment

• Antipsychotic medications
• Thorazine (conventional, typical)
• Tardive dyskinesia serious side effect
• Clozaril (atypical)
• Case Management
• Family Therapy
• Psychotherapy usually NOT appropriate

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Conclusions

• Schizophrenia affects about 1 of the worlds
  population and disables more people than any
  other physical or mental disorder.
• The cost to society is enormous. Direct medical
  care in the U. S. is estimated to be 20 billion
  dollars per year (Torrey, 1995). Loss of
  productivity is incalculable.
• There is excellent research going on in many
  areas-- neuroscience, genetics, molecular
  biology, psychology, pharmacology, and other
  areas.
• We should have the genes identified in the next
  five years.